AI-powered CX to support members after H.R. 1

Summary

• H.R. 1 disrupts U.S. healthcare coverage with Medicaid work requirements, stricter ACA subsidy rules, and increased administrative burdens, potentially displacing millions from coverage.
• AI-powered digital CX platforms enable payers to respond with proactive guidance, real-time data insights, and personalized member support to reduce churn and maintain continuity of care.
• Payers that adapt now can build trust, sustain member relationships, and ensure healthier outcomes despite market volatility.

The One Big Beautiful Bill Act (OBBB), or H.R. 1, signed into law on July 4, 2025, fundamentally reshapes U.S. healthcare. This comprehensive legislation directly impacts Medicaid, the Affordable Care Act (ACA) Marketplace, and Medicare, leading to widespread shifts in coverage. For payers, H.R. 1 brings an undeniable reality of market change and potential member dislocation. Health plans must adopt strategies focused on empathetic and efficient member engagement to help individuals navigate an increasingly more complex healthcare system and, by extension, maintain stability within the marketplace. Advanced digital platforms, particularly those leveraging AI, serve as powerful enablers for these essential strategies.

Understanding H.R. 1’s  Direct Impact on Coverage

H.R. 1 introduces provisions that directly affect individuals’ access to coverage and, consequently, payer operations:

• Medicaid Restructuring: The bill implements stronger work requirements for Medicaid eligibility (80 hours per month), removes rules easing CHIP and Medicaid renewals, and mandates more frequent eligibility checks (every 6 months). It also limits provider taxes, making state Medicaid funding harder, and introduces cost-sharing for enrollees above the federal poverty line. The Congressional Budget Office estimates 11.8 million individuals could lose coverage due to these changes.
• Exchange Market Shifts: H.R. 1 restricts premium tax credits for many migrants and implements stricter eligibility and income verifications for subsidy recipients. It also shortens the annual enrollment period and ends premium tax credit eligibility during special enrollment periods.
• Increased Administrative Burden: New eligibility rules, work requirements, and increased checks demand more frequent processes and higher staff burden, creating significant administrative complexities for payers and, crucially, for members trying to maintain their coverage.

These changes collectively put payers at risk for increased churn, fewer subsidized members, tighter margins, and a growing population cycling in and out of coverage. Payers can no longer rely on traditional engagement strategies. Millions risk falling through the cracks unless payers proactively help individuals stay connected, informed, and engaged with their care.

AI-Driven CX: An Essential Strategy for Member Support

Amidst this volatility, a supportive and clear consumer experience stands as an essential strategic imperative. This involves a set of proactive approaches designed to support members through transitions in coverage and marketplace complexities. AI-powered, platform-based experiences are vital tools that can ignite health engagement, guiding members to the right care at the right time. This proactive support helps prevent costly episodes, reduces medical loss, and ultimately supports member continuity. Providing genuine engagement to help people stay healthy, compliant, and connected to care is vital, especially as traditional safety nets become less robust.

Core Strategies for Navigating H.R. 1

To effectively navigate the H.R. 1’s complexities and maintain stability, U.S. payers must prioritize the following areas of focus, significantly enhanced by advanced digital platforms:

• Operationalize Data for Responsive Service: H.R. 1 creates significant administrative and eligibility tracking complexities. A key strategy involves unifying and leveraging disparate data sources to gain real-time insights into evolving enrollment trends and member needs. This data-driven approach allows payers to identify areas to improve service and make informed decisions about health programs. Advanced digital platforms facilitate this by automating processes like appointment scheduling and claims processing, reducing administrative overhead and enabling a more adaptive and responsive service model for members under new funding landscapes.
• Implement Proactive Guidance to Maintain Coverage: Preventing coverage gaps is crucial for both members and payers. This strategy centers on establishing communication channels that proactively alert members to changes and guide them through eligibility requirements. Digital platforms are instrumental here, enabling proactive reminders, form completion assistance, and clear next steps to help members meet new work, income, and eligibility rules before they lose coverage. Digital nudges facilitate renewals, redeterminations, and reporting, helping ensure members do not drop off due to paperwork or a lack of timely information.
• Enhance Care Access through Digital Channels: As traditional care access may become more limited, especially in rural areas, expanding digital pathways for care becomes a vital strategy. This involves supporting telehealth expansion and guiding members efficiently to appropriate, lower-cost care solutions. AI-driven CX platforms are instrumental, facilitating virtual access to doctors and benefits, reducing travel needs and expanding care access in underserved regions. They also increase the utilization of existing point solutions, guiding members to the most appropriate resources at the right time through personalized health journeys.
• Build Consumer Trust and Sustain Member Relationships: With millions potentially becoming uninsured or underinsured, building trust and reliability is paramount. The strategy here is to establish consistent, empathetic digital outreach that meets members where they are. This helps them feel understood and supported in a system that often overlooks individual needs. By providing critical information and care reminders through personalization and health journeys, advanced platforms empower individuals to manage their care, reducing preventable high-cost claims and improving overall outcomes for individuals and families.

The One Big Beautiful Bill Act (OBBBA), or H.R. 1, presents an undeniable challenge to U.S. payers and the members they serve. However, strategically investing in and implementing the approaches outlined above, amplified by AI-driven customer experience platforms like League, payers can transform this challenge into an opportunity for essential support of underserved populations. By focusing on proactive engagement, operationalizing data for better service, and delivering a seamless, personalized member journey, payers can not only help members navigate a complex landscape but also foster trust, promote continuity of care, and establish greater stability for their plans. Adapting now positions forward-thinking payers to lead as H.R. 1 impacts the market, ensuring healthier outcomes for members and a more secure future for their organizations.